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Supervisor, Utilization Management Technician

1 week, 5 days ago
United States
Full-time
Junior
Operations Manager
Customer and Technical Support
HIPAA
Apply Now
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017
View All Jobs 42

Description

  • Oversee a group of prior authorization technicians and handle select administrative prior authorization functions.
  • Analyze available data with the pharmacy technician manager and recommend improvements to staffing, workflow, and systems.
  • Support ongoing training and coaching for utilization management pharmacy technicians.
  • Participate in goal setting, review direct report performance, and address performance or behavioral issues as needed.
  • Investigate and resolve escalated issues from clients and providers.
  • Collaborate with the utilization management manager on projects, implementations, and other initiatives as needed.
  • Review pharmacy claims data to identify opportunities for proactive outreach and intervention.
  • Maintain quality and productivity standards while minimizing compliance risk.
  • Prepare prior authorization requests by validating prescriber and member information, review level, and clinical guidelines.
  • Obtain clinical information from prescribers, referral coordinators, and other staff to support pharmacist review.
  • Identify, document, and escalate provider concerns to the appropriate internal teams.
  • Triage calls from members, pharmacy personnel, and providers and communicate issues and resolutions clearly.
  • Follow internal SOPs, HIPAA guidelines, and company policies while delivering customer care in a fast-paced environment.

Requirements

  • At least 1 year of Medicare experience, including working knowledge of policies and guidelines.
  • Minimum 1 year of Medicare prior authorization and/or Medicare appeals experience.
  • Demonstrated ability to communicate effectively and manage team priorities.
  • Strong organizational and problem-solving skills.
  • Active, unrestricted National Certified Pharmacy Technician (CPhT) license required.
  • Proficiency in Microsoft Office Suite, especially Excel and PowerPoint.
  • Strong clinical background required.
  • Excellent communication, writing, and organizational skills.
  • Ability to multi-task and collaborate in a team with shifting priorities.
  • 2+ years of leadership experience preferred.
  • Strong understanding of CMS regulations and payer requirements preferred.
  • 2+ years of PBM or managed care pharmacy experience preferred.
  • Ability to work flexible schedules, including weekends, and participate in an on-call weekend and holiday rotation.

Benefits

  • Remote work for non-local candidates or hybrid work for local NYC-area candidates.
  • Base salary of $70,000 to $80,000 USD, depending on location and other factors.
  • Medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts.
  • Health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for full-time employees.
  • Paid time off, sick time, and holidays.
  • Short-term disability, long-term disability, employee assistance program, and wellness program.
  • 401(k) plan with company match after one year of full-time employment.

Interested in this position?

Apply directly on the company website

Apply Now

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